乳腺癌新辅助化疗后前哨淋巴结活检术的研究

目的 探讨乳腺癌病人新辅助化疗后前哨淋巴结活检的可行性。方法对2003年11月至2004年10月住院治疗中的57例Ⅱ、Ⅲ期乳腺癌病人行新辅助化疗后，临床检查腋窝淋巴结阴性行前哨淋巴结活检术（SLNB）。结果57例中检出前哨淋巴结（SLN）53例，检出率93．0％。SLN对腋窝淋巴结状况预测的敏感性为89．7％，特异性为100．0％，准确性为94．3％，阳性预测值为100．0％，阴性预测值为88．9％，假阴性率为5．7％。肿瘤对化疗反应为CR（完全缓解）、PR（部分缓解）和SD（稳定）的SLN检出率分别为100．0％、96．7％和70．0％（P〈0．01）。SLN假阴性3例均为腋窝淋巴结转移数〉4个者。结论Ⅱ、Ⅲ期乳腺癌实施新辅助化疗后。行SLNB可获得与早期乳腺癌SLNB相似的效果。     

美蓝染色法检测乳腺癌前哨淋巴结的临床研究

目的 寻找检测乳腺癌前哨淋巴结(SLN)方法，研究前哨淋巴结活检(SLNB)预测腋窝淋巴结状况的准确性。方法 对40例乳腺癌患者行美蓝染色法检测SLN，并行腋窝淋巴结清扫术(ALND)后，将腋窝淋巴结转移状况与SLN进行对比分析，分析SLN检出率及临床特征。结果 40例患者中成功检测出SLN35例，成功率为87．5％。检出SLN60个，平均每例检出SLNl．7个。2例出现假阴性，假阴性率为10.5％，无假阳性。35例患者中有16例SLN阳性，阳性率为45.7％。SLNB预测腋窝淋巴结(ALN)的敏感性为88．8％，特异性为100％，准确性为94．4％。结论 美蓝染色法检测乳腺癌SLN经济实用，可以较准确地预测腋窝淋巴结的转移状况。     

国产亚甲蓝行早期乳腺癌前哨淋巴结活检的观察

目的：探讨前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）反映早期乳腺癌腋淋巴结转移情况，并指导临床腋淋巴结阴性（cN0）乳腺癌腋窝淋巴结清除范围的可行性。方法：使用国产1％亚甲蓝对120例cT1.2N0M0期乳腺癌病人进行前哨淋巴结活检，于原发肿瘤边缘上、下、左、右选取4个注射点．将1％亚甲蓝4m1分别注射到乳腺实质及皮下组织内，已行术中活检则注射于残腔壁周围及其表面的皮下组织内。注射后从注射点向腋窝方向轻按摩5～10min，以利于淋巴管和淋巴结的染色，随后行乳腺癌改良根治手术或保乳手术。SLN常规HE染色病理检查．阴性者通过免疫组化方法行淋巴结微转移检查。结果：确定SLN87例，成功率为72．50％。SLNB的特异度为100％．假阳性率为0％，假阴性率为1．5％，准确率为98．85％；阴性前哨淋巴结的微转移率为4．44％。结论：前哨淋巴结转移状况基本上可反映乳腺癌腋淋巴结转移的状况；SLNB有望成为指导cN0，期乳腺癌腋淋巴结清除范围的方法。     

原发性乳腺癌患者非哨兵淋巴结转移预测因素的研究

目的探讨原发性乳腺癌患者哨兵淋巴结活检(SLNB)后，哨兵淋巴结(SN)转移者非哨兵淋巴结(NSN)转移相关的临床及组织学因素。方法252例确诊为原发性乳腺癌患者SLNB后行腋窝淋巴结清扫，所有的腋窝淋巴结(SN及NSN)均行常规组织学检查。应用X^2检验分析年龄，肿瘤大小，肿瘤位置，病理类型，受体状态和SN转移数目与NSN转移的关系。结果SLNB成功率94％，假阴性率7．4％。随着原发肿瘤的增大，NSN转移的可能性增加：T1a T1b期肿瘤NSN转移率为0；T1c期为42％；T2期为87％。只有1个SN转移的患者NSN转移率明显低于多个SN转移的患者(27％vs46％)。结论NSN转移的可能性随着原发肿瘤的增大和多个SN转移而增加，而患者的年龄，肿瘤的位置，病理类型和受体状态不影响NSN转移的可能性。     

前哨淋巴结快速活检在乳腺癌根治术中的意义

目的：探讨乳腺癌前哨淋巴结活检(sentinel lymph node biopsy，SLNB)的可行性和准确性，及其在乳腺癌手术中的临床应用价值。方法：对32例乳腺癌病人行SLNB，术中在肿瘤周边选二点注射1％美蓝5ml，根据肿块距腋窝的距离，5～10min后沿腋窝下皱折线切开，循蓝染淋巴管寻找前哨淋巴结(sentinel lymp hnode，SLN)。其中27例切除SLN后行腋窝淋巴结解剖(axillry lymph node dissection，ALND)，两标本同时送病理检查，了解其符合率，并评价SLNB的可行性。结果:全组均进行了SLNB识别定位，1例未取到SLN，检出率为96．9％；另一例SLN病理呈假阴性。按目前国外SLNB的评价标准，本组SLNB的敏感度为88．2％，准确性为96．9％，假阳性率为0，假阴性率为5．9％。结论:乳腺癌SLNB目前仍处于研究阶段，随着研究的深入与扩大，将成为早期乳腺癌的诊疗常规，阴性可避免ALND的痛苦。     

在固定解剖位置进行乳癌前哨淋巴结活检初探

目的证明乳癌前哨淋巴结(SLN)有固定的解剖位置，无需借助淋巴示踪技术亦能检出。方法Ⅰ～Ⅱ期乳癌术中，先于腋毛区最下缘作一2cm左右横切口，在该区域内找到1。3粒淋巴结，定义为SIN，与继后腋窝清扫所得的非前哨淋巴结(NSLN)进行病理结果对比分析。结果SLN阳性者占总检测者的55．6％(21)／36)；前哨淋巴结活检(SLNB)的准确率、灵敏度、阳性和阴性预测值分别为91．7％、94．7％、90．0％、93．8％。1例SIN病检阴性而NSLN阳性，假阴性率为2．8％(1／36)。结论无需借助淋巴示踪技术，在腋毛区最下缘检出的SLN可准确反映乳癌患者腋窝状况，故腋毛区最下缘是SIN的固定解剖位置。     

乳腺癌新辅助化疗后前哨淋巴结活检的初步研究

目的研究乳腺癌新辅助化疗后前哨淋巴结活检（SLNB）的可行性和效果。方法利用新型示踪剂——^99mTc-利妥昔配合专利蓝染料对60例原发性乳腺癌新辅助化疗后病例进行SLNB，并对SLN进行常规病理检查和免疫组织化学检查。SLNB后常规腋窝淋巴结清扫。结果SLN检测成功率95％（57／60）。SLN转移阳性23例（40％），其中18例为常规病理检查转移阳性（78％），5例为免疫组织化学检出的微转移（22％）。23例SLN有转移病例中，9例同时存在其他腋窝淋巴结转移，另外14例为惟一转移淋巴结。1例SLN转移假阴性。灵敏度96％（23／24），准确性98％（56／57），特异度100％（33／33），假阴性率4．3％（1／23），阴性预测值97％（36／37），阳性预测值100％（24／24）。内乳淋巴结显像11例，活检病理检查均为转移阴性。结论同位素示踪剂和蓝染料联合检测方法对原发性乳腺癌新辅助化疗后进行SLNB同样适用，内乳前哨淋巴结活检不应做常规推荐。     

超声定位下可疑淋巴结取样在早期乳腺癌手术中的临床研究

目的 探讨早期乳腺癌更为合理的腋窝淋巴结处理方法,明确腋窝可疑淋巴结取样结合前哨淋巴结活检(SLNB)替代单纯SLNB时的假阴性率是否明显降低,为临床应用提供依据.方法 采用传统的腋窝淋巴结外科学分群方法,对符合入组条件的42例早期乳腺癌患者术前行B超引导下钩丝定位,术中行腋窝SLNB和定位的可疑淋巴结活检,再行全腋窝...     

乳晕下亚甲蓝法乳腺癌前哨淋巴结活检术169例应用报告

目的探讨乳晕下注射亚甲蓝示踪法进行前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)在乳腺癌治疗中的意义。方法 2005年1月～2010年3月,对169例(年龄33～70岁,中位年龄45岁)临床腋窝淋巴结阴性的乳腺癌术中乳晕下注射亚甲蓝2 ml行SLNB。SLN病理为阴性的患者,SLNB替代腋窝淋巴结清扫术。结果 163例(96.4%)成功实施SLNB,6例(3.6%)术中未能发现SLN,立即改行腋窝淋巴结清扫术(axillary lymph node dissection,ALND)。行SLNB的163例中,23例术中冰冻报告SLN癌转移,即行ALND;140例冰冻切片检查SLN未见癌转移。6例术后HE染色检查发现SLN存在1枚微转移淋巴结,5例接受ALND,1例拒绝行腋窝淋巴结清扫。135例SLNB代替ALND者中位随访时间16个月(3～62个月),均未发现腋窝淋巴结转移。结论亚甲蓝法SLNB安全、有效、简便易行,SLNB阴性的患者,可以替代ALND。     

前哨淋巴结活检术在Ⅰ、Ⅱ期乳腺癌患者手术中的应用效果

目的观察分析前哨淋巴结活检术(SLNB)在Ⅰ、Ⅱ期乳腺癌手术中的近期效果。方法选取2015-03—2017-06间鹤壁市人民医院收治的92例Ⅰ、Ⅱ期乳腺癌患者,根据不同术式分为2组,各46例。观察组均实施前哨淋巴结活检术(SLNB),且为SLNB呈阴性的患者不行腋窝淋巴结清扫术(ALND)。对照组不行SLNB,均直接行常规乳腺癌改良根治术。比较2组患者术后患侧肩关节功能受损程度及免疫功能。结果观察组患侧肩关节功能受损程度明显轻于对照组,免疫功能明显优于对照组,差异均有统计学意义(P0.05)。结论对Ⅰ、Ⅱ期乳腺癌患者实施SLNB,对SLNB阴性的患者不行ALND,可明显减轻患者术后患侧肩关节功能受损程度,对患者免疫功能的影响较小,有利于改善预后。     

乳腺癌前哨淋巴结活检

目的 评价前哨淋巴结活检预测腋窝淋巴结有无肿瘤转移的准确性及其临床意义。方法 用^99m锝－硫胶体作为示踪剂,用γ探测仪导向,对70例临床分期为T1－2N0M0的乳腺癌患者进行前哨淋巴结活检,所有的患者均同时行腋窝淋巴结清扫,HE染色阴性的前哨淋巴结再切片,用CK8、CK19、KP－1行免疫组织化学染色。结果 70例患者中成功发现前哨淋巴结的有67例,发现率为95.7%（67／70）。前哨淋巴结的数量为1－5枚,平均每例1.6枚。非前哨淋巴结5－20枚,平均例12.3枚。67例前哨淋巴结活检成功的患者中,29例患者（43.3%）有腋窝淋巴结转移,其中前哨淋巴结有转移者24例（35.8%）,前哨淋巴结未发现转移而非前哨淋巴结有转移者5例（7.5%）。7例患者（10.4%）只有有淋巴结为阳性淋巴结,前哨淋巴结活检的准确性为100％。43例患者的65枚HE染色阴性一的前哨淋巴结,CK8及CK19免疫组织化学染色均为阴性。结论 前哨淋巴结检能较准确地预测腋窝淋巴结转移情况,对原发灶为T1的乳腺癌,前哨淋巴结活检的准确性为100％。同一层面切片行免疫组织化学染色并不能提高淋巴结微转移癌的发现率。     

前哨淋巴结检测在乳腺癌治疗中的意义

目的评价前哨淋巴结活检术 (sentinellymphnodebiopsy,SLNB)预测腋淋巴结肿瘤转移的准确性及其临床意义。方法使用专利蓝染色法和 /或99mTc标记的硫胶体示踪法对我院收治的81例乳腺癌患者进行前哨淋巴结活检。两种方法联合检测 3例前哨淋巴结 (sentinellymphnode ,SLN)均阴性者未行腋淋巴结清扫术。结果 81例患者SLN总检出率为 96 3% (78/81) ,总准确率为97 5 % ,总假阴性率 9 7%。 5 3例单纯染色法检出率为 92 5 % ,准确率 94 2 % ,假阴性率 15 8% ;2 8例99mTc示踪法和 /或染色法联合检测结果分别为 10 0 % ,10 0 %和 0。结论SLNB能够准确预测腋窝淋巴结的转移状况。两种方法联合检测为最佳。术前化疗对假阴性率可能有影响。     

临床腋淋巴结阴性乳腺癌前哨淋巴结研究

目的：探讨前哨淋巴结活检术（ｓｅｎｔｉｎｅｌ ｌｙｍｐｈ ｎｏｄｅ ｂｉｏｐｓｙ, ＳＬＮＢ）在乳腺癌治疗中的应用。方法：使用专利蓝和美蓝染色,对１９９９年９月～２００１年４月连续收治的１４５例临床查体腋窝淋巴结阴性乳腺癌病人行前哨淋巴结活检术。结果：ＳＬＮＢ成功率为９６．５％（１４０／１４５）,假阴性率为２３．５％,准确率为９１．４％。病人年龄、肿瘤最大径、肿瘤部位、注射染料类型及是否活检对成功率和假阴性率无影响。结论：ＳＬＮＢ能够准确预测腋窝淋巴结的转移状况,在缩小手术范围、减少术后并发症的同时,提高了腋窝淋巴结分期的准确性;美蓝与专利蓝均可成功确定ＳＬＮ。     

γ探测仪在乳腺癌前哨淋巴结定位活检中的应用

目的:探讨γ探测仪在临床腋窝淋巴结阴性乳腺癌前哨淋巴结定位活检术(SLNB)中的临床应用价值.方法:利用99m锝-右旋糖酐(99mTc-DX)作为前哨淋巴结(SLN)示踪剂,应用γ探测仪定位对29例临床腋窝淋巴结阴性乳腺癌病人实施SLNB,随后进行常规腋窝淋巴清扫术,分析SLNB对腋窝淋巴结转移状态的预测价值.结果:本组SLN转移率为41.67%,非SLN转移率仅为22.54%,两者有明显差异(P＜0.001).在19例常规病理SLN阴性病人中,连续切片发现2例SLN微转移.在12例SLN癌转移中,5例(41.66%)SLN为惟一的转移部位.有1例SLN阴性病人"跳跃转移".本组SLN的敏感性为92.31%,特异性为94.12%,假阴性为7.69%,准确率达96.55%.结论:SLN能准确反映早期乳腺癌腋窝淋巴结转移状态,连续切片能提高SLNB的准确性.     

Sentinel lymphadenectomy accurately predicts nodal status in T2 breast cancer

Background: Sentinel lymph node biopsy (SLNB) has emerged as a reliable, accurate method of staging the axilla for early breast cancer. Although widely accepted for T1 lesions, its use in larger tumors remains controversial. This study was undertaken to define the role of SLNB for T2 breast cancer.

Study Design: From a prospective breast sentinel lymph node database of 1,627 patients accrued between September 1996 and November 1999, we identified 223 patients with clinical T1-2N0 breast cancer who underwent 224 lymphatic mapping procedures and SLNB followed by a standard axillary lymph node dissection (ALND). Preoperative lymphatic mapping was performed by injection of unfiltered technetium 99 sulfur colloid and isosulfan blue dye. Data about patient and tumor characteristics and the status of the sentinel lymph nodes and the axillary nodes were analyzed. Statistics were performed using Fisher’s exact test.

Results: Two hundred four of 224 sentinel lymph node mapping procedures (91%) were successful. Median tumor size was 2.0 cm (range 0.2 to 4.8 cm). One hundred forty-five of the 204 patients had T1 lesions and 59 patients had T2 lesions. There were 92 pathologically positive axillae, 5 (5%) of which were not evident either by SLNB or by intraoperative clinical examination. The false-negative rate and accuracy were not significantly different between the two groups, but axillary node metastases were observed more frequently with T2 than with T1 tumors (p = 0.005); other factors, including patient age, prior surgical biopsy, upper-outer quadrant tumor location, and tumor lymphovascular invasion were not associated with a higher incidence of false-negative SLNB in either T1 or T2 tumors.

Conclusions: SLNB is as accurate for T2 tumors as it is for T1 tumors. Because no tumor or patient characteristics predict a high false-negative rate, all patients with T1-2N0 breast cancer should be considered candidates for the procedure. Complete clinical examination of the axilla should be undertaken to avoid missing palpable axillary nodal metastases.     

Sentinel Lymph Node Biopsy for Breast Cancer: Current Controversies

Abstract:   Sentinel lymph node biopsy (SLNB) has replaced the routine level I and II axillary lymph node dissection (ALND) for women with clinically node-negative T1 and T2 breast cancer. Studies have shown that SLNB is highly predictive of axillary nodal status with a false-negative of rate less than 10%. Our purpose was to address some of the ongoing controversies about this procedure, including technical issues, use of preoperative lymphoscintigraphy, internal mammary lymph node biopsy, criteria for patient selection (in intraductal carcinoma?), its staging accuracy, and the clinical approach when a SLNB was found to be negative or positive on pathologic examination. After the revision of the American Joint Committee on Cancer (AJCC) staging system for breast cancer in 2002, the evaluation of internal mammary lymph nodes and determination of micrometastases by hematoxylin-eosin or by immunohistochemistry have become increasingly important in staging of patients. Recent guideline recommendations developed by the American Society of Clinical Oncology (ASCO) Expert Panel in 2005 are also discussed. Long-term follow-up results of ongoing studies will provide more accurate assessment of the prognostic significance of SLNB and its value in the prevention of breast cancer-related morbidity in axillary staging compared to ALND.      

Sentinel lymph node biopsy after neoadjuvant chemotherapy in a patient with operable breast cancer

PURPOSE: This study was undertaken to assess the feasibility of performing a sentinel lymph node biopsy (SLNB) for a patient with operable breast cancer after undergoing neoadjuvant chemotherapy (NAC). METHOD: Between January 2002 and December 2003, women with primary breast cancer who had a breast tumor measuring larger than 3 cm in unilateral diameter were eligible for NAC. All patients who had completed NAC underwent lymphatic mapping with labeled (99m)Tc phytate on the day before surgery. Sentinel lymph node biopsy followed by a full axillary lymph node (AXLN) dissection (ALND) was performed in all patients. Sentinel lymph nodes (SLN) were sent for a frozen-section examination. RESULTS: The rate of SLN identification was 71%. Both the sensitivity and negative predictive value of SLNB were 100%. The false negative rate was 0%. When candidates for SLNB were restricted to patients with a breast tumor measuring less than 3 cm and clinically negative nodes after NAC, the rate of SLN identification increased to 93% from 71% while still maintaining the 0% false negative rate. CONCLUSION: Sentinel lymph node biopsy after NAC is therefore considered to be a feasible and accurate method to predict the AXLN status in patients who have a breast tumor measuring less than 3 cm in unilateral diameter and a clinically negative AXLN status at the time of surgery after NAC.     

Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy

BACKGROUND: Radiolocalization and selective biopsy of the sentinel node to correctly predict the status of remaining lymph nodes may provide an alternative to axillary dissection in selected breast cancer patients with clinically negative lymph nodes. STUDY DESIGN: In a nonrandomized, multicenter clinical trial, gamma probe localization for lymphatic mapping and sentinel node biopsy along with axillary dissection was performed on 75 patients with invasive breast cancer and clinically negative lymph nodes. The accuracy of the sentinel node biopsy to correctly predict the status of the remaining axillary lymph nodes was established through standard pathologic investigation. RESULTS: A sentinel node was identified in 70 of 75 patients with a technical success rate of 93%. Of these 70 patients, 21 (30%) had axillary nodal metastases identified pathologically. Four of these 21 (19%) had sentinel nodes negative for metastases. All 4 false-negative patients had prior excisional biopsies. The false-negative group had a larger mean maximal biopsy dimension than the true-positive group. Eleven of the 21 patients with axillary metastases had a diagnosis made by core needle biopsy with no false negatives. CONCLUSIONS: The accuracy of the sentinel node biopsy in correctly predicting the status of remaining axillary lymph nodes may be limited in patients with large excision before radiolocalization of the sentinel node. Our findings suggest that excisional biopsy should be avoided prior to lymphatic mapping for sentinel node biopsy.     

前哨淋巴结活检对乳腺癌新辅助化疗后腋窝状况评估中的价值

目的 研究前哨淋巴结活检在乳腺癌新辅助化疗后的临床应用价值。方法 选择我院2007年9月至2010年11月期间收治的46例Ⅱ、Ⅲ期乳腺癌患者,接受新辅助化疗后超声检查腋窝淋巴结阴性者为研究对象。所有患者前哨淋巴结活检后行乳腺癌改良根治术及标准腋窝淋巴结清扫,所有前哨淋巴结行病理和免疫组化检查,非前哨淋巴结行常规病理检查。结果 前哨淋巴结活检的成功率、假阴性率、灵敏度、特异性、精确性、阳性预测值、阴性预测值分别是93.5%,3.7%,96.3%,100%,97.7%,100%,94.1%。结论 前哨淋巴结活检结合超声可以较准确的评价新辅助化疗后乳腺癌的腋窝淋巴结状态,对于决定患者是否需要行腋窝淋巴结清扫有一定参考价值。